Pan Arab Journal of Oncology - Arab Medical Association Against ...

only 20% to 60%. Consequently, the lack of preventive care delivery translates to
lost opportunities to decrease morbidity and mortality via primary and secondary
prevention. Furthermore, spending time to discuss prevention with a patient was
perceived by some physicians as not being a prominent element in the role of
doctor nor an effective use of physician time, hence, the task of prevention could
be delegated to other members of the medical team.8
In the case of preventive services guidelines, implementation needs to go beyond
traditional dissemination and promotion efforts to recognize the added patient and
clinician barriers that affect preventive care.9 These barriers include:
1. Clinicians' ambivalence about whether preventive medicine is part of their job
2. The psychological and practical challenges that patients face in changing
behaviors
3. Lack of access to health care or of insurance coverage for preventive services
offered to some patients.
4. Competing pressures within the context of shorter office visits and lack of time
5. The lack of organized systems in most practices to ensure the delivery of
preventive care recommendation.
The physicians intellectually support the worth of primary prevention, but can
not easily insert and/or rationalize it into the culture and expectations of clinical
practice. Therefore, a persistent public health objective is to develop and implement
strategies to overcome the barriers that deter provision of primary preventive
services. A necessary goal of such strategies would be to raise the perceived
worth and priority of primary prevention within the PCP community, furthermore
physicians need to expand their self-perceived clinical role to take fuller advantage
of their unique position to deliver primary preventive care.10
Implementation Strategies
The following practice strategies were recommended to help to overcome these barriers:1
1. Adopt a scientifically based preventive protocol
PCP should be familiar with rational screening criteria,11 together with
recommendations of experts and accredited organizations like, Canadian Task
Force,12 American Cancer Society13, US preventive services task force,14,15
and American College of Physician.16,17 Meanwhile, they must establish an
evidence-based health-maintenance protocol appropriate to their situation and
benefits, with a strong preventive segment that deal with behavioral modifications
and early diagnosis for the public. This protocol must contain enough flexibility
to accommodate different cohorts of patients having a variety of risk factors.
Meanwhile, to be applicable to a wide variety of health care situations including
public hospitals, clinics, health centers, as well as group and individuals practices.
2. Development of a Preventive Attitude
Within the physician who in turn could translate it into educating him or her self
in preventive and screening procedures. The PCP must learn to communicate with
their patients in a positive, enthusiastic way to stimulate them to consider being
subjected to cancer control measures and early detection plan.
3. Engage the Patient
Strategies must be developed to have patients as partners to share the responsibility
for health maintenance. Using patient's handouts, which can stress this responsibility,
and educate them about the preventive protocol. Another tool is the patient's health
diaries which contain health maintenance flow charts to be filled by the patient.
Recently, at higher technical level portable personalized computer smart cards
which are shaped like credit cards, can contain the patient's medical record data.18
4. Institutionalize Prevention & Early Detection
It means committing time and resources to ensure prevention occurs on a regular
basis for all patients. This strategy is the most important and is the one many
practices are reluctant to do. Using clear simple guidelines and accurate easy
methodology for ensuring periodic evaluation feedback. While, it is mandatory
to identify a coordinator and/or auditor responsible for ensuring integrity of the
health maintenance tracking system and give feedback about PCP compliance
with the recommended practice.
5. Time Management19
Time saving can be achieved by performing only proven health maintenance
procedures, as well as keeping an organized record system, but these steps alone
may not be enough. The incorporation of physician assistants and the use of
paramedical staff, and nurse practitioners as members of the team can be very
helpful.
The Role of Cancer Prevention in Practice
Cancers occur not as a sudden catastrophic events, but rather as a the result of a
complex and long-evolving process. Carcinogenesis can take decades to evolve
completely, providing time and opportunity to intervene to stop or to reverse its
progress either before the clinical appearance of cancer or at its earliest stages. Due
to to the continuing burden, public health interventions have focused on prevention
and early detection to reduce cancer incidence and mortality.20
Behavior change is a difficult task for both patient and PCP. Physicians believe
that implementing patient behavior change required changing the patient's
mindset, yet significant barriers were related to physicians themselves.21 They
acknowledged their lack of training, knowledge, and skill in behavior change
process and recommendation conveyance. With participation of both patient and
PCP about cancer, in addition to the development of a strong preventive attitude,
the stage will be set for the long term appropriate prevention and early detection
implementing strategy. For most individuals who are not symptomatic for cancer
and in good health, unless a physician suggests their participation in a prevention
study, they are likely to remain unaware of this option.
As cancer prevention has matured and proved its role in the science and practice of
oncology. The American Society of Clinical Oncology (ASCO) has strengthened its
commitment to cancer prevention by establishing its Cancer Prevention Committee
(CAPC) in 2002. With the major objectives are to improve preventive interventions,
expand these efforts globally, also to collaborate with FDA on regulatory issues
involved with preventive drug development.6 Another positive mark, was
publication of the comprehensive Institute of Medicine report, which offers
recommendations to increase the rates of adoption, the reach, and the impact of
evidence-based cancer prevention and early detection interventions.8
Since cancer can be caused by a variety of different factors and may develop over a
number of years, therefore some risk factors can be controlled. Choosing the right
health behaviors and preventing exposure to certain environmental risk factors
can help prevent the development of cancer. For these reasons, it is important to
follow national trends to monitor the reduction of these risk factors which focus
on national trends data from two major groups of risk factors: Behavioral and
Environmental factors.22
I. Behavioral Factors
Scientists estimate that as many as 50–75 percent of cancer deaths are caused by
human behaviors such as smoking, physical inactivity, and poor dietary choices.
Major reduction in cancer incidence are possible through improved nutrition,
physical activity, and avoidance of tobacco products. The latter being the only
www.amaac.info Pan Arab Journal of Oncology | vol 3; issue 1 | March 10 < 89